Compare and Contrast

Gerontologic Nursing Is the field of nursing that specializes in the care of the elderly. Geriatrics the study of old age, includes the physiology, pathology, diagnosis & management of the disease of older adults.

Ageism

term to describe the deep & profound prejudice in American society against older adults. discrimination based solely on age.

When Does Aging Begin?

Aging begins the day we are born No single measure of how old a person is. Aging is highly individualized Aging proceeds at different rates in different people, and within different systems of the body

Chronological Categories

Young-old: 65 to 75 years Old: 75 to 85 years Old-old : 85 to 100 years Elite old: Over 100 years

Demographic

Advancement in disease control, living conditions, and health technology

65 year old woman may live to another 19 years, a 65 year old man may reach the age of 81.

Socioeconomic
GENDER Women have a longer life expectancy than men. More likely to be widowed Men higher remarriage Level of education; Affect the socioeconomic status (higher education is assoc. w/ higher incomes)

Ethnicity

Ethnicity WHITE BLACK ASIAN HISPANIC

2003 Census 83% 8% 3% 6%

2050 projection 61% 12% 8% 18%

How different cultures view Elders

Chinese value of total respect for the family esp. the elders. Native American -respected for their wisdom, experience and knowledge -assume significant roles as teachers and caretakers of the young Hispanic/Latino -are held in high esteem -Care for elders is provided by the extended family. Children is expected to care for their elderly parents.

Health

Chronic health problems & disabilities increase as age increases.

Cancer Arthritis,

osteoporosis Diabetes mellitus Nutrition & obesity

Common Biologic Theories of Aging What causes the body to age..

WEAR AND TEAR THEORY

Proposes that humans, like automobiles, have vital parts that run down with time, leading to aging and death.

Endocrine Theory

Proposes that events occuring in the hypothalamus & pituitary are responsible for changes in hormone production that result in the organism decline.

Free Radical Theory

Unstable free radicals cause biochemical changes in the cells, & the cells cannot regenerate themselves.

Genetic Theories

organism is genetically programmed for predetermined number of cell division, after w/c the cells / organism dies.

Cross-linking Theories

As we age, collagen in body ages also. Causes hypertension and other organ malfunctions Causes loss of elasticity, stiffness and eventual loss of function.

Immunological Theories

Immune system becomes less effective w/ age, resulting in reduced resistance to infectious disease and viruses.

Care Settings for Elders

Acute Care Facilities nurses focus on protecting the health of older adult and the goal of the elder adult returning to his/her prior level of independence.

Long-term Care Facilities objective to provide a place of safety & care to attain optimal wellness & independence. Assisted living- elders who do not feel safe living alone or require additional help w/ activities of daily living. Intermediate care- elders are no longer able to live independently , this level of care provides 24-hour direct nursing contact. Skilled care units- elders who require a higher level of nursing care. (clients w/ tube feeding, chronic wounds & ventilators).

Hospice for dying elderly clients.

Requires

great deal of patience, expertise, understanding, interdisciplinary communication & compassion skills on the part of the nurse.

PHYSIOLOGICAL AGING OF THE HUMAN BODY BY SYSTEMS

Integument (SKIN, HAIR, NAILS)

Loss of subcutaneous fat (double chin, sagging of eyelids) Thinning of skin (wrinkling of skin) Decreased collagen Nails brittle and flake Mucous membranes drier Less sweat glands Temperature regulation difficult Hair pigment decreases

Health Teachings

Maintaining healthy skin

Ensure optimal nutrition Maintain adequate hydration Prevent skin dryness using emolient lotions after bathing / showering Avoid skin products contains perfume or alcohol Avoiding sun damage Use sun screen lotions SPF of 15 or higher Wear wide brimmed hats, sun visors, sunglasses Preventing skin injury Do not use strong detergent to launder clothes. Use soft washclothes

EYES AND VISION

Eyelids baggy and wrinkled Eyes deeper in sockets Conjunctiva thinner and yellow Quantity of tears decreases Iris fades Pupils smaller, let in less light Night and depth vision less Floaters can appear Lens enlarges

Eyes and Vision

Lens becomes less transparent Can actually become clouded Results in cataract

Predisposed to glaucoma Increased pressure in eye

Decreased absorption of intraocular fluid

Can result in blindness

Accommodation decreases Results in presbyopia Impaired color vision, also - especially greens and blues Because cones degenerate

Macular degeneration becoming more frequent This is the patch of retina where lens focuses light Ultimately results in blindness

Reason for current increase in this condition unknown

Health teachings
How to help mitigate the effects of vision loss: 1. Increase lighting 2. Use blinds or shades to reduce glare 3. Maintain equal levels of lighting

EARS AND HEARING LOSS

Irreversible, sensorineural loss with age Men more affected than women Called presbycusis Loss occurs in higher range of sound By 60 years, most adults have trouble hearing above 4000Hz Normal speech 5002000H

RESPIRATORY SYSTEM

Lungs become more rigid Pulmonary function decreases Number and size of alveoli decreases Vital capacity declines Reduction in respiratory fluid Bony changes in chest cavity Decreased cough efficiency, reduced ciliary activity Vulnerable to respiratory

CARDIOVASCULAR SYSTEM

Heart smaller and less elastic with age By age 70 cardiac output reduced 70% Heart valves become sclerotic & tortuous. Heart muscle more irritable & arteries lose their elasticity. More arrhythmias Arteries more rigid Veins dilate

GASTROINTESTINAL SYSTEM

Reduced GI secretions Reduced GI motility Decreased weight of liver Reduced regenerative capacity of liver Liver metabolizes less efficiently

RENAL SYSTEM

After 40 renal function decreases By 90 lose 50% of function Filtration and reabsorption reduced Size and number of nephrons decrease Bladder muscles weaken Less able to clear drugs from system Smaller kidneys and bladder

REPRODUCTIVE SYSTEM
Male: Reduced testosterone level Testes atrophy and soften Decrease in sperm production Seminal fluid decreases and more viscous Erections take more time Refractory period after ejaculation may lengthen to days

REPRODUCTIVE SYSTEM
Female: Declining estrogen and progesterone levels Ovulation ceases Introitus constricts and loses elasticity Vagina atrophies shorter and drier Uterus shrinks Breasts pendulous and lose elasticity

NEUROLOGICAL SYSTEM

Neurons of central and peripheral nervous system degenerate Nerve transmission slows Hypothalamus less effective in regulating body temperature Reduced REM sleep, decreased deep sleep After 50% lose 1% of neurons each year

Good NEWS
Intellectual functioning defined as Stored memory increases with age Problem solving skills increase with age Older people are able to learn very well How to help: Allow time Minimize distractions Use it or lose it

MUSCULOSCELETAL SYSTEM

Adipose tissue increases with age Lean body mass decreases Bone mineral content diminished Decrease in height from narrow vertebral spaces Less resilient connective tissue Synovial fluid more viscous May have exaggerated curvature of spine

IMMUNE SYSTEM

Decline in immune function Trouble differentiating between self and nonself - more auto-immune problems Decreases antibody response Fatty marrow replaced red marrow Vitamin B12 absorption might decrease decreased hemoglobin and hematocrit

ENDOCRINE SYSTEM

Decreased ability to tolerate stress best seen in glucose metabolism Estrogen levels decrease in women Other hormonal decreases include testosterone, aldosterone, cortisol, progesterone

MENTAL HEALTH DISORDERS

ALZHEIMERS DISEASE

1.

2.

3.

A chronic condition characterized by declining intellectual capacity. It causes gradual loss of memory accompanied by loss of at least 1 other cognitive function, such as : language, abstraction or spatial orientation. CAUSES: NEUROFIBRILLARY TANGLES these twisted clumps of protein are found in damaged nerve cells. NEURITIC PLAQUES clusters of dying neurons and abnormal nerve terminals form plaques. BETA AMYLOID this dense, starch-like protein forms the core of neuritic plaques.

a. b.

Aluminum is a toxin predisposes an individual to develop Alzheimers disease. SYMPTOMATOLOGY: 5As: agnosia, apraxia, aphasia, amnesia, anomia confabulation, sun downing TREATMENT: NSAIDs ANTIOXIDANTS : vitamin E DRUG OF CHOICE: ARICEPT given OD in AM (insomnia) COGNEX given QID (hepatotoxic) NURSING INTERVENTIONS: Attend physiologic needs of the patient. Provide safety and security ID CARD & BRACELET, SIDE RAILS, LOCKED DOOR Present an alternative home care setting

Offer activity which is simple & attainable Offer reality orientation clock, calendar, colors and consistency only 1 care giver will handle the client and will repeat every now and then his/her name Reminiscence photo album and diary Pet therapy to develop sense of responsibility

PARKINSONS DISEASE

AKA: PARALYSIS AGITANS

MALES/FEMALES : 50-60years old Degenerative disease ----- EPS ---loss of neurons DOPAMINE.

PATHOPHYSIOLOGY:

Depigmentation of the substantia nigra of the basal ganglia DOPAMINE.

ASSESSMENT: a. pill rolling tremors of the fingers b. unintentional tremors c. rigidity d. mask like appearance e. drooling of saliva f. shuffling gait g. microphonia h. microphagia

COLLABORATIVE MANAGEMENT:
1. 2.

Diet = increase caloric and residue, soft diet. Position to prevent contracture : firm bed, no pillows, prone when lying, hold hands folded at the back when walking Aspiration precaution. increase OFI to prevent constipation ANTICHOLINERGICS: to reduce tremors

3. 4.

Cogentin, Artane, Akineton

SIDE EFFECTS: blurring of vision, dryness of mouth/throat, constipation, urinary retention ANTI-PARKINSONIAN: to improve muscle flexibility

5.

6.

Levodopa, Carbidopa with levodopa

Avoid the following drugs when on LEVODOPA therapy: Phenothiazines, Reserpine, Pyridoxine

MAOI

Conclusion

We all change physically, as we grow older Some systems slow down, while others lose their "fine tuning." People who live an active lifestyle lose less muscle mass and flexibility as they age As a general rule, slight, gradual changes are common, and most of these are not problems to the person who experiences them Steps can be taken to help prevent illness and injury, and which help maximize the older person's independence, if problems do occur There is no need for most people to fear getting older

Thanks for listening !